Almost 40 years after the initial description of HIV in men who have sex with men (MSM) in the United States of America, the global community faces re-emerging and newly documented HIV epidemics in MSM. The estimated median HIV prevalence in MSM ranges from 5% in South-East Asia to 12.6% in Eastern and Southern Africa. In 2019, MSM accounted for 44% of new HIV infections in Asia and the Pacific (2019 data, UNAIDS). Globally, the risk of acquiring HIV is 26 times higher among MSM compared to the general population.

Moreover, MSM populations have relatively high rates of hepatitis C virus (HCV) prevalence and incidence – specifically among MSM living with HIV and MSM using pre-exposure prophylaxis (PrEP). A global review found that the pooled HCV prevalence in HIV-positive MSM was 6.3%, compared to 1.5% in HIV-negative MSM (1).

Worldwide, syphilis is a highly prevalent infection among MSM. In 2019, syphilis infected an average of 11.8% (range 5.2% to 19.6%) of MSM in 11 of 25 reporting countries; 7 of these countries had a prevalence higher than 10%. Untreated syphilis can lead to serious complications in 25% of infected individuals who do not receive diagnosis and treatment. These complications can be severe and even life-threatening, and can also increase the risk of HIV acquisition and transmission (WHO, GHO, 2020).

In some settings, criminalization of consensual adult same-sex behaviour, as well as stigma, discrimination and violence against MSM, have created an environment that compromises people’s human rights and makes them less likely to access health services for HIV, viral hepatitis, sexually transmitted infections (STIs) and other essential services.

WHO supports partners to implement, scale up and improve sustained, comprehensive and effective HIV prevention, testing and treatment efforts targeting MSM in low-, middle- and high-income countries. WHO also supports partners to address structural barriers such as criminalization, stigma and discrimination.

Furthermore, WHO supports efforts to increase access to evidence-based STI and viral hepatitis prevention, testing and treatment for MSM at higher risk. Existing HIV and PrEP programmes for MSM should include STI and HCV testing and treatment, and should offer adapted prevention interventions.

WHO works closely with the Joint United Nations Programme on HIV/AIDS (UNAIDS), MPACT Global Action for Gay Men’s Health & Rights, and other stakeholders to advocate for implementation of an evidence- and human rights-based approach to the prevention, diagnosis and treatment of HIV, viral hepatitis and other STIs, and to monitor the performance and impact of this implementation.

(1)  Jin et al, 2020 Lancet Gastrohep